From large-scale initiatives that bundle enhanced revenue cycle functions with overall organization performance, to new technology implementations, to effectively leveraging outside expertise, modernizing the revenue cycle involves more than taking a few steps and is more of a journey.

Architecting a modernization process is best begun by developing and documenting process workflows and overlaying functional areas.  Generally, there are three phases to consider that align with different functional areas.

    • Pre-visit and POS Activities
    • Coding and Charging
    • Post Charging and Resolution to $0 Balance

With this workflow process plan in hand, you can then begin to apply a process to attack different aspects of these processes and how they are related. It quickly becomes obvious that having trusted shared data at every step of the process is very important.

A general approach might look like the following:

        1. Optimize the Process
        • Integrate a workflow system to orchestrate the manual processes and measure and monitor hold-ups
        • Simplify and adapt the workflow (from the point of care onwards) and better align the human resources to the process
        • Trigger alerts on high-value transactions stuck in the workflow and deploy fix-it experts
        • Automate the information hand-offs to reduce workflow steps
        • Apply AI clinical natural-language engines to automate and improve the accuracy of the coding process at multiple points
        • Identify exception root causes along the 80/20 rule
        1. Use Workflow Automation to Identify and Fix Leakage
        • Analyze patient visits that result in lost revenue, overlay the rev cycle workflow history that leads to such outcomes, zero in on the hotspots and rewire workflows to mitigate the leakage
        • Implement automation to reduce human error
        • Apply workflow automation to control external processes that heavily impact revenue cycle performance – physician onboarding and credentialing for example
        1. Align Outcome-based Reimbursement Processes
        • Implement data analytics around impediments to healthier outcomes, create a population health analytic risk map
        • Construct patient health journey maps, align them against your value-based incentives and penalties, forecast your revenue upside and downside across your as-is population
        • Gain visibility into health complexities in your population to support better value-based contract negotiations
        • Identify patient profiles that are incompatible with the business models and reduce such patients (until payer contracts better compensate for such)
        1. Measure Service, Ancillary and Payer Mix
        • Apply metrics on payer, service type and ancillary workflow overhead
        • Evaluate operational costs against the revenue benefits
        • Optimize or eliminate high cost lower benefit lines (and do the inverse)
        1. Synchronize with the Accounting Process
        • Automatically assign and split provider and service area revenue to the correct financial accounts
        • Automatically assign and split ancillary revenue to the correct financial accounts
        • Flag ancillary expenses that don’t align with the claim details
        • Feedback receivable aging issues upstream with the revenue cycle decision-making process

The new healthcare paradigm is altering how leaders approach revenue cycle challenges. Being open to new methods and solutions is necessary to achieve patient-centered, value-based care. Everyone needs to continue to adapt, elevating operations to rethink, retool, and reenergize their financial operations—for many of the same reasons they have improved their clinical operations